Chapter 35 Family Interventions Varcarolis

You are evaluating the family therapy experience. Which behavior would indicate that further family therapy is needed? a. Wife talks to husband through the children. b. Son's grades have risen from a "D" average to a "C" average. c. Daughter's headaches have subsided. d. Mother has stopped using illicit substances.

a. Wife talks to husband through the children

Just before you escort the Juarez family in for a meeting, their 17-year-old son confides to you that he is gay. He says he has not told any other adult including his parents. What is your best response to him? a. "Your parents have a right to know about this." b. "How do you think your parents would react if you told them?" c. "That's your decision, but you need to be careful about risky sexual behavior." d. "Lots of famous people are gay. You don't need to worry."

b. "How do you think your parents would react if you told them?"

Which of the following family members should you refer to individual therapy rather than family therapy? a. A mother who has anxiety controlled by medication. b. A father who is questioning his sexuality. c. A son who is verbally abusive toward his parents. d. A daughter who has been treated for alcohol use.

b. A father who is questioning his sexuality.

A 10-year-old shares that he doesn't like spending weekends with his father "now that dad's girlfriend moved in." The nurse will discuss the issues with the child and parents based on an understanding of the stresses present in which type of family structure? a. Unmarried biological b. Cohabitating c. Blended d. Other

b. Cohabitating

A nurse works with patients whose families are attending family therapy. The nurse should recommend psychoeducational family therapy for which family? a. A family whose members have problems establishing and respecting boundaries. b. A family whose teenaged children are routinely making major family decisions. c. A family whose 18-year-old son has been diagnosed with schizophrenia. d. A family who communicates primary using dysfunctional techniques.

c. A family whose 18-year-old son has been diagnosed with schizophrenia.

While you are working with a family whose son was admitted due to a psychotic break, you observe the mother say to her son, "What, no hug for your Mom?" As the son embraces his mother, she stiffens, which results in the young man backing away. She responds, "You only care about yourself." What behavior is this mother engaging in? a. Triangulation b. Scapegoating c. Double binding d. Differentiation

c. Double binding

When performing an intake assessment on a family, you wish to map the family's structure and information that reflect both the family's history and current functioning. This assessment tool is called a: a. Mini-mental status exam b. Beck depression inventory c. Genogram d. Histogram

c. Genogram

A 24-year-old is leaving the family to start a new job in a city 400 miles away. Which statement made by the patient best demonstrates a healthy sense of family support? a. "I've always been independent. That's how I was raised." b. "If I get in trouble financially, I know Mom and Dad will help me out." c. "I don't need anyone's help. Everyone has their own problems to deal with." d. "I'm going to miss everyone terribly, but I know they will support me in this decision."

d. "I'm going to miss everyone terribly, but I know they will support me in this decision."

Which statement is an example of a parent demonstrating the dysfunctional communication technique of generalizing? a. "I want to be a good mother, but my husband just isn't involved with the kids." b. "I keep the peace by seldom asking any of the family to help with chores." c. "My wife's priorities are the kids, her parents, and then her job." d. "The kids never listen to me even when I threaten them."

d. "The kids never listen to me even when I threaten them."

A nuclear family consists of married parents, a 16-year-old daughter, and a 19-year-old son recently diagnosed with schizophrenia. The rest of the family is bewildered with his symptoms and express that they feel lost in knowing how to deal with things. Which of the following approaches to family therapy should the nurse implement at this time to provide support and give information to the family that will help them cope with their son's illness? a. Insight-oriented family therapy b. Multigenerational family therapy c. Behavioral family therapy d. Psychoeducational family therapy

d. Psychoeducational family therapy

A nurse works with a nuclear family that includes an adult child diagnosed with schizophrenia. The child's mother confides that she and her husband "have not been getting along well." She states that her teenage daughter provides much support to her and claims that "she doesn't really like her dad much anymore and doesn't talk to him." The nurse suspects that the family is experiencing which family dysfunctional dynamic? a. Boundary blurring b. Neglect c. Emotional abuse d. Triangulation

d. Triangulation

The nurse wants to assess a family's rational patterns by creating their genogram. Which statement best describes the purpose of such an analysis? A. "A genogram will help me see your family structure, history, and current functioning." b. "A genogram is a tool used for deciding on the best type of therapy for your family." c. "A genogram will assess risk for mental illness in future generations." d. "A genogram will help us determine the cause of Jeremy's schizophrenia."

A. "A genogram will help me see your family structure, history, and current functioning."

What term best describes a family dynamic where boundaries are not clear and whose members are overinvolved with each other? a. Enmeshment b. Scapegoating c. Clear boundaries d. Rigid boundaries

a. Enmeshment

Emotional support is an important family dynamic because it allows family members to: a. Feel secure enough to explore aspects of their personality. b. Feel isolated and fearful even though family members are near. c. Grow without boundaries within the family unit. d. Have bursts of anger without recourse or shame.

a. Feel secure enough to explore aspects of their personality.

Which family situation should the nurse assess as warranting a referral for family therapy? A. A couple is having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope." B. A couple is having their first child. They say, "It's certainly going to be a change for us." C. The parents of a blended family with five children ranging in age from 5 to 15 years say, "It's never quiet, but the disagreements eventually get worked out." D. A husband and wife are sending a son off to college and planning their daughter's wedding. They say, "Soon we will be back to having an empty nest again."

A. A couple is having difficulty dealing with the erratic behavior of their bipolar son. They say, "We're at the end of our rope." The family in option C is the only family system clearly expressing an unmanageable degree of stress. The other systems may be undergoing stress but have not expressed distress.

Which situation is the best example of a double bind? A. A wife sighs while telling her husband, "You can go out with the boys tonight if it's what you really want to do." B. A man says, "I was surprised and delighted when my entry was chosen for an award." C. A mother tells her son, "Under no circumstances will I give you permission to stay out after midnight." D. A roommate states, "I would prefer to have you call if you think you are going to be late for dinner."

A. A wife sighs while telling her husband, "You can go out with the boys tonight if it's what you really want to do." A double bind is created when the verbal and nonverbal messages are incongruent, leaving the listener confused or trapped ("damned if he does and damned if he doesn't"). None of the other options present such a confused message.

During a family therapy session a wife states, "My husband is always angry. The children and I are always on edge. We can never relax." The nurse identifies the wife's communication technique using which term? A. Generalizing B. Placating C. Manipulating D. Distracting

A. Generalizing Generalization involves making global statements using "always" and "never" when dealing with problematic family issues. Generalization allows the speaker to avoid dealing with specific examples. None of the other options describes the provided conversation.

A 26-year-old client diagnosed with schizophrenia is having difficulty adjusting to the community after hospitalization. His family is dismayed by his poor hygiene and avolition. Which intervention should the nurse suggest? A. The client attending a psychoeducational group B. Encourage the family to ignore all symptoms except delusions. C. Close supervision of the client by the family D. Suggest group home living for the client in order to avoid family burnout.

A. The client attending a psychoeducational group Psychoeducation can help the family learn to accept the illness of a family member, learn to deal effectively with symptoms, and understand medications. None of the other options provide a realistic, effective intervention to manage this client's socialization and self-care issues.

The client disagrees that her husband should seek a promotion since it will require the family to move. After she discusses the situation with their 12-year-old, the child tells her father she does not want to move. The client has engaged in which form of dysfunction family dynamics? A. Triangulation B. Diffuse boundaries C. Enmeshment D. A double bind

A. Triangulation Triangulation occurs when a two-person relationship is under stress and one person draws in a third person to stabilize the system by forming a coalition.

During a family therapy session the mother says to her daughter, "I would like to know why you took the piece of pie that was left after dinner last night. You knew I wanted it." Later the father tells his daughter, "I know exactly why you did that." The nurse therapist should consider the possibility that the family is demonstrating which boundary issue A. Inflexible B. Diffused C. Disengaged D. Clear

B. Diffused A common phenomenon within families with diffuse boundaries is that individuals expect other members of the family to know what they are thinking. The described conversation is not reflective of any of the other options.

Which assessment tool is highly effective in uncovering multigenerational issues in a family? A. Focused interview B. Genogram C. Family function checklist D. Family assessment device

B. Genogram A genogram maps family structure and family information for at least three generations. It graphically depicts relational patterns and multigenerational issues. Demographics, sociocultural context, and critical events can be noted. While helpful, none of the remaining options focus on multigenerational issues.

A girl is overheard saying to her brother, "If you stick up for me with mom and dad, I will forget I heard you planning to sneak out after they are asleep." This can be assessed as what type of communication? A. Placating B. Manipulative C. Generalizing D. Scapegoating

B. Manipulative One example of manipulation occurs when a family member makes a request with strings attached so that the other person has difficulty refusing. This example is not associated with any of the other options.

During family therapy the family's youngest daughter says, "They care more about my sister because she's older and gets straight As in school." Which nursing diagnosis should be given priority? A. Parental role conflict B. Relational problems C. Deficient knowledge D. Defensive coping

B. Relational problems This discourse concerns relational problems related to a mental disorder, a generic medical condition, or a sibling relational problem. No data suggests the other diagnoses.

The family consists of the husband and his wife, their four children, the wife's 21-year-old sister, and client's elderly aunt. Which members are considered the client's nuclear family? A. The husband and his aunt B. The parents and their four children C. The wife and her sister D. The four children and the wife's sister

B. The parents and their four children The term nuclear family refers to parents and the children under the parents' care.

What is the primary function of the nurse generalist in caring for families? A. Determining the new skills the family needs B. Conducting private family therapy sessions C. Prescribing psychobiological intervention D. Assessing the amount of stress on the system

D. Assessing the amount of stress on the system An important function of a nurse generalist is to assess cues from various family members that indicate the degree and amount of stress the family system is experiencing and report these so that appropriate interventions may be made in a timely manner by a qualified counselor. The remaining options are outside the scope of practice of a psychiatric nurse generalist.

A family consists of a husband, a wife, their three children, and the wife's mother. This family form is referred to using which term? A. Blended B. Indwelling C. Dyadic D. Extended

D. Extended An extended family (multigenerational) is a composite of three or more generations. None of the other options refer to this family composition.

The members of a family openly tell each other what they are thinking and feeling. A nurse listening to their interchanges would assess their communication using which term? A. Disengaged B. Double-bind C. Generalizing D. Healthy

D. Healthy Healthy communication is exemplified by being clear and direct in saying what you want and need. The other terms are used to describe some form of dysfunctional communication.

The family that consists of a married mother and father and three biological children all living together is referred to using which term? a. Other family b. Cohabitating family c. Blended family d. Nuclear family

Nuclear family

At the first therapy session the family's father tells the therapist that "We wouldn't have to be here if our younger son wasn't such a brat. He seems so different from our other son. We never had difficulty with him misbehaving." The other sibling offers "He gets upset pretty easily." The nurse should suspect that the younger son is the focus of which family dynamic behavior? A. Scapegoating B. Boundaries resisting C. Differentiation D. Multigenerational transition.

Scapegoating A scapegoat is the person others blame for the family's distress. Those blaming the scapegoat are usually trying to keep the focus off their own painful issues and problems. The parents seem to be scapegoating the younger son. The information presented does not support any of the other options.

At what point would the nurse expect a family to demonstrate the greatest dislocation in the family life cycle? A. When the couple renegotiates the marital system as a dyad B. When the couple is deciding whether to have children C. When a member is diagnosed with multiple sclerosis D. When the first child enters school

When a member is diagnosed with multiple sclerosis Family stress is often the greatest at times of serious illness, death, or divorce. While the other options can produce levels of stress, none are as stressful as coping with a family member's chronic illness.